Progress Stalled in Cutting Teen HIV Risk

Action Points

Explain that reductions in sexual and injection-drug-use HIV-related risk behaviors occurred among high school students from 1991-2011 but had largely leveled off from 2001-2011.

Note that risk behaviors were especially decreased among black students but still remained higher than in other racial/ethnic groups.

WASHINGTON -- Teens today are practicing safer sex than they were 2 decades ago, but most of the progress in reducing their risk of HIV came before 2001, researchers reported here.

For instance, among black students, condom use increased from 1991 to 1999 -- from 48% to 70% -- but then decreased from 1999 to 2011, dropping to 65.3%, Laura Kann, PhD, of the CDC, and colleagues reported at the International AIDS Conference and simultaneously in Morbidity and Mortality Weekly Report.

In addition, there was little change in the number of Hispanic students who reported having had four or more sexual partners -- 16.8% in 1991 and 14.9% in 2001, decreasing only slightly to 14.8% in 2011.

Although risky sexual behavior dropped among all students during the 20-year study period, "during the past decade, we've seen a stalling in those decreases and we're very concerned because they haven't continued to decrease," Kann said.

The findings came from the Youth Risk Behavior Study (YRBS) for 1991 to 2011, which anonymously samples public and private high school students in 50 states and the District of Columbia in grades 9 to 12 every 2 years, asking about health risk behaviors.

Patients under the age of 30 represent a disproportionate number of new HIV infections -- 39% of all new infections from a demographic that represents 21% of the population, the researchers noted in their report. "Too many young people in this country continue to be infected with HIV," Kann said.

Among high school students overall, the survey results in various categories included:

Ever had sexual intercourse: 54.1% in 1991 versus 45.6% in 2001 and 47.4% in 2011

Had sex with four or more partners so far: 18.7% versus 14.2% and 15.3%

Currently sexually active: 37.5% versus 33.4% and 33.7%

Used a condom during last sexual experience: 46.2% in 1991 versus 63.0% in 2003 (the peak year) and 60.2% in 2011

Looking at specific groups, black teens today are less likely to engage in sexual behavior that puts them at risk for HIV than black teens were in 1991, although rates are still higher among blacks than among whites and Hispanics.

For example, 60% of black teens surveyed in 2011 said they had engaged in sexual intercourse compared with 81.5% of black teens surveyed in 1991.

But today's 60% for blacks far outpaces, the 44.3% of whites and 48.6% of Hispanics.

Although potential causes were not assessed through the YRBS, Kann noted that "other research [found] that many other sexual health risk behaviors are driven by socioeconomic factors, such as poverty, lower educational levels, and also factors such as stigma and discrimination, and those may disproportionately affect some of the populations that are at greatest risk for HIV."

She added that "it's one of the reasons we not only need to address the risk behaviors, but the underlying factors that are driving those behaviors if we're really hoping to get a handle on rates of risk among young people."

A school education about HIV prevention is itself one of the best preventive tactics, Kann said. "That is one opportunity for [students] to learn about the risks associated with HIV, how to get themselves tested, and how to prevent HIV that some may not be getting now."